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Title: Weight loss and weight maintenance interventions for adults with intellectual disabilities
Author: Spanos, Dimitrios
Awarding Body: University of Glasgow
Current Institution: University of Glasgow
Date of Award: 2013
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Background: The prevalence of obesity is higher in adults with intellectual disabilities (ID) than in the general population, with increased rates of secondary health risks and increased mortality rates. Multi-component weight loss interventions have been advocated by current UK clinical guidelines for all adults without ID. Such interventions incorporate dietary changes that produce an energy deficit, increased levels of physical activity and the use of behavioural approaches to promote and sustain changes in physical activity and dietary patterns, followed by a weight maintenance intervention. However, UK clinical guidelines have reported that the evidence base for the treatment of obesity in adults with ID is minimal. New evidence in this area of research could be used for the development of accessible weight management interventions for adults with ID and lead to a sustainable clinically significant weight loss. Methods: Study 1: A systematic review aiming to evaluate the clinical effectiveness of weight management interventions in adults with ID and obesity using recommendations from current clinical guidelines for the management of obesity in adults. Full text papers published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. The assessment of the quality of the studies and interventions was based on the criteria of the Centre for Reviews and Dissemination (CRD) (University of York) and the PRISMA checklist. Study 2: The evidence base for the development of weight maintenance interventions in adults with ID is limited. This study presents the findings of the second phase of a multi-component weight management programme for adults with ID and obesity (TAKE 5). A total of 31 completers of the 16 week weight loss intervention of the TAKE 5 programme were invited to participate in a 12 month weight maintenance intervention. The TAKE 5 weight maintenance intervention included monthly one to one sessions and monthly phone calls, using the recommendations of the Glasgow and Clyde Weight Management Service (GCWMS) and of the National Weight Control Registry. The intervention provided a dietary advice based on the estimated energy requirements of each participant, advice to improve physical activity and behavioural approach techniques to facilitate changes in physical and dietary patterns. Participants’ body weight, BMI, waist circumference (WC) and levels of physical activity were measured before and after the intervention. Paired t tests were used to assess differences in anthropometric and physical activity measurements. Study 3: 52 participants of the TAKE 5 weight loss programme were individually matched by baseline characteristics (gender, age and BMI) with two participants without ID of the GCWMS programme. Non parametric significance tests were used for comparisons between groups in terms of weight and BMI change and rate of weight loss. In addition, data from the 52 completers with ID of the TAKE 5 weight loss intervention were used to perform a univariate logistic regression analysis for the identification of socio-biological predictors for absolute weight loss and clinically significant weight loss at 16 weeks. Study 4: Semi-structured interviews were used to explore the experiences of 24 carers that supported participants of the TAKE 5 weight loss programme. The transcripts were analysed qualitatively using the qualitative data software analysis package, ATLAS ti 5.2 software. Thematic analysis was used to examine potential themes within data. Results: Study 1: Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225-300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (≥ 5%) at six months post intervention. Study 2: 28 participants completed the TAKE 5 weight maintenance intervention. Most of the participants (50.4%) maintained their weight (mean weight change=-0.5kg; SD= 2.2) within ± 3% from initial body weight at the end of the weight maintenance intervention. There was no statistically significant change in BMI and WC at 12 months from BMI and WC at the end of the 16 week weight loss intervention. There was no statistically significant decrease in the time spent in sedentary behaviour and no statistically significant increase in the time spent in light and in moderate to vigorous physical activity. At the end of the weight maintenance intervention participants spent less days walking (at least 10 minutes) than at the end of the end of the weight loss intervention (P<0.05). Study 3: There were no significant differences between participants with ID and participants without ID in the amount of weight loss (median:-3.6 vs. -3.8, respectively, P=0.4), change in BMI (median: -1.5 vs. -1.4, P=0.9), success of achieving 5% weight loss (41.3% vs. 36.8%, P=0.9) and rate of weight loss across the 16 week intervention. Only, initial weight loss at four weeks was positively correlated with absolute weight loss at 16 weeks (P<0.05). Study 4: Three themes emerged from the analysis: Carers’ perceptions of participants’ health; barriers and facilitators to weight loss; and carers’ perceptions of the weight loss intervention. Data analysis showed similarities between the experiences reported by the carers who supported participants who lost weight and participants who did not. Lack of sufficient support from people from the internal and external environment of individuals with ID and poor communication among carers, were identified as being barriers to change. The need for accessible resources tailored to aid weight loss among adults with ID was also highlighted. Conclusions: Study 1: Weight management interventions in adults with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified. Study 2: The TAKE 5 weight maintenance intervention can effectively support adults with ID maintain their weight. Assessment of the cost effectiveness of the TAKE 5 weight management programme is justified. Study 3: The TAKE 5 multi-component weight loss intervention in its current structure can be equally effective for adults with ID as in adults without ID and obesity. A study with a larger sample could facilitate the identification of sociological and biological predictors for weight loss in adults with ID. Study 4: This study identified specific facilitators and barriers experienced by carers during the process of supporting obese adults with ID to lose weight. Future research could utilise these findings to inform appropriate and effective weight management interventions for individuals with ID.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA Public aspects of medicine